◆ Mild anemia

RENAL DISORDERS ◆ Diuretic Phase ◆ Edema, weakness and fatigue.

● Glomerular filtration rate ◆ Increased BP
Renal Failure increases ◆ GFR - pregressive decrease from 90
a. Acute (reversible) ● Urine output rises slowly to 30 mL/min
➔ Causes: then diuresis occurs 4-5 L / ◆ Increased BUN, serum creatinine,
◆ Prerenal - sudden and severe drop day. serum K.
in blood pressure or interruption of ● Gradual decline in BUN and ◆ Decreased ability to concentrate
blood flow to kidney from severe creatinine. urine.
injury/illness. ◆ Recovery Phase (Convalescent) ➔ Nsg interventions
◆ Intrarenal - direct damage to kidney ● Slow process (1-2 yrs) ◆ Monitor vital signs, i&O, level of
by inflammation, toxins, drugs, ● Urine volume is normal consciousness, weight (increase of
infection, or reduced blood supply. ● BUN stable and normal 0.5 -1 lb / day indicates retention.)
◆ Postrenal - sudden obstruction of ● Client can develop Chronic ◆ Monitor BUN, creatinine, electrolyte,
urine flow due to enlarged prostate, Renal Failure. specific gravity and urinalysis, CBC /
kidney stones, bladder tumor or b. Chronic Renal Failure doctor’s orders.
injury. ➔ Progessive loss and deterioration in kidney ◆ Monitor for acidosis, give sodium
➔ Phases of Acute Renal Failure function that occurs over a slow period. bicarb / doctor’s orders.
◆ Oliguric Phase ➔ Causes: ◆ Assess for dysrhythmia due to
● Sudden drop in urine ◆ Follows acute renal failure. hyperkalemia.
output (<400mL / day) ◆ Diabetes mellitus, hpn. ◆ Fluid overload (edema and r??)
● Hyperkalemia ◆ Autoimmune disorders (Lupus ➔ Prescribed diet
● Normal sodium level / Erhyth.) ◆ Moderate protein to decrease
decreased ◆ Recurrent infections kidney workload,
● Signs of fluid overload ◆ Chronic urinary obstruction ◆ High carbohydrate, low potassium
(edma, CHF) ◆ Renal artery occlusion. and phosphorus, sodium restriction
● Signs of acidosis and hpn. ➔ Assessment: ◆ Fluids from 400 - 1000 mL; always
● Elevated BUN and ◆ Headache, edema, decreased ability monitor urine output
creatinine. to concentrate. ◆ Be alert for nephrotoxic medication
◆ Polyuria to oliguria
 13. Ocular irritation - due to calcium deposits in GLOMERULONEPHRITIS
SPECIAL PROBLEMS IN RENAL FAILURE conjunctiva; medication to control calcium and - Result in proliferative inflammatory
1. Hypertension - fluid and sodium restrictions; phosphate levels; administer lubricating eye drops. destruction and sclerosis of glomeruli.
diuretics and anti-hpn and beta-adrenergic 14. Insomnia and fatigue - due to build up of waste - Hx of pharyngitis or tonsillitis
antagonists. products; provide adequate rest period; mild CNS
2. Hypervolemia - monitor VS, I&O, weight and edema, depressant as prescribed. a. Acute
electrolytes and signs of CHF; restrict fluid, give 15. Neurological changes - build up of active particles ➔ Occurs 2-3 weeks post streptococcal
diuretics. and fluids causing change in brain cells; monitor for infection; group A beta-hemolytic.
3. Hypovolemia - if dehydrated, replacement therapy is confusion and level of consciousness; provide safety ➔ Hx of pharyngitis or tonsillitis
followed. and comfort measures. b. Chronic
4. Potassium retention - may cause dysrhythmia, 16. Psychosocial changes - monitor for depression; ➔ Occurs after acute phase, slowly over time.
monitor peaked T-waves; food low in potassium. anxiety, denial, and suicidal behavior, changes in
5. Phosphorus retention - give aluminum hydroxide, body image. - Nursing Interventions
other phosphate binders and laxatives; phosphorus ○ Monitor VS, I&O, weight, edema,
restriction diet. ascites, signs of CHF
6. Low calcium - due to high phosphorus; give calcium NEPHROTIC SYNDROME ○ Restrict fluid intake and sodium as
supplement and vit. D; monitor calcium level. - Assessment: ordered.
7. Metabolic acidosis - inability to excrete hydrogen ○ Presence of hematuria, proteinuria, azotemia ○ Provide bed rest and limited activity.
ions; administer sodium bicarb as ordered. (nitrogen containing), oliguria, blurred vision ○ DIET - high calorie, low protein.
8. Anemia - administer BT; monitor for bleeding. and edema. ○ MEDS - diuretics, antihypertensives,
9. GI bleeding - ammonia (mucosal irritant) causes - Nursing Intervention antibiotics.
ulcerations and bleeding; monitor hematocrit, ○ Monitor vital signs, I&O, potassium levels,
hemoglobin and occult blood in stools. bed rest (severe edema), mild sodium
10. Infection and Injury restrictions, administer diuretics,
11. Muscle cramps - electrolyte imbalance; corticosteroids, plasma volume expanders,
replacements. Massage lower legs. and anticoagulants.
12. Pruritus - urate crystals excreted through skin
(uremic frost); advance renal failure. Provide good
skin care and oral hygiene; avoid use of soap.
antipruritics.
UROLITHIASIS * Interventions RENAL TRAUMA
- Formation of urinary stones in the ureter. ➔ Strain urine - any material left in the strainer is sent - Grade I-V
for analysis. - Grade I - normal contusion and hematoma;
NEPHROLITHIASIS microscopic hematuria; normal urologic
- Formation of stones in the kidney. CYSTITIS / URINARY TRACT INFECTION findings
- Inflammation of bladder from infection or - Grade II - hematoma lacerations, hematoma
* Causes: obstruction of area. confined in retroperitoneal areas
➔ Family hx of stone formation. - Most common Escherichia coli, enterobacter, - Grade III - renal laceration > 1 cm
➔ Diet high in calcium, vit D, milk, protein, oxalate, pseudomonas. - Grade IV - laceration vascular injury, renal
purines (ex. dinuguan/ internal organs)or alkali. - More common in women, than in men; shorter laceration extending through renal cortex;
➔ Obstruction and urinary stasis. urethra and location is close to rectum; sexually involving renal artery
➔ Dehydration and use of diuretics. active and pregnant women and most vulnerable for - Grade V - laceration vascular injury,
➔ UTI’s, prolonged catheterization. cystitis. shattered kidneys, ureteropelvic junction
➔ Elevated uric acid (e.g. gout). - Assessment avulsion, thrombosis of main renal artery.
➢ Hematuria
➢ Incomplete emptying of bladder BLADDER TRAUMA
➢ Lower abdominal or back discomfort - Puncture in bladder by cystoscope.
➢ Cloudy, drk, foul smelling urine
➢ Malaise, chills, fever, nausea and vomiting URETERAL AND URETHRAL TRAUMA
➢ Bladder spasms - Urethra is hurt by force
➢ Frequency, urgency and burning sensation - Causes
during urination ➢ Road traffic accident
- Implementation ➢ Blow, kick or fall
➢ Obtain urine specimen for culture and ➢ Stbas, gunshot wounds
sensitivity ➢ Endoscopic trauma
➢ Force fluids (up to 3000 mL / day) ➢ Diathermy
➢ Avoid caffeine products and alcohol ➢ Instrumentations (ex. Hysterectomy,
➢ Provide heat to abdomen or sitz bath herniotomy, excision of rectum, LSCS etc.)
➢ Medication: analgesics, antibiotics, * lower segment ces. sec.
antispasmodics.
 - Management
➢ Catheter inserted for 12 - 21 days to allow for
healing; if after 21 days and problems are still
observed - catheter use will be extended.

NEPHROSCLEROSIS
- Hardening of walls of small arteries and arterioles of
kidney
- Caused by hypertension

HYDRONEPHROSIS
- Swelling of kidney due to build up of urine
- Urine cannot drain out from kidney due to blockage
or obstruction

RENAL ABSCESS
- Abscess of kidney
- Assessment
- Fever, chills, flank pain, weight loss, pain
when urinating, bloody urine, malaise
- Management
- Antibiotics (IVTT), draining pus from abscess.
TREATMENT MODALITIES ♡ Peritoneum - semi-permeable sack lining ♡ The Exchange Procedure
the abdominal cavity and covering organs. ✧ Drain Phase
Renal failure
♡ Specific time set by doctor = the time to ○ Patient is seated
- Renal failure is the 7th leading cause of death among
drain comfortably; *** is infused,
Filipinos.
♡ Cleans blood through diffusion - passage of left inside for a few hours
- One filipino develops chronic renal failure every hour
particles across semi-permeable membrane and then drained in the
/ 120 / million every year.
from greater to lower area of concentration same bag.
- 5000 presently undergoing dialysis
until equilibrium is achieved. ✧ Infusion Phase
- 205 receive therapy; the rest will die in 6 months.
♡ Cleans blood through osmosis - area of low ✧ Dwell Phase
TREATMENT CHOICES
concentration to area of higher ○ Let the solution stay for
- Peritoneal dialysis
concentration. how many hours; follow
- Hemodialysis
doctor’s order
- Kidney transplant
○ Patient is able to do
activities.
➔ Peritoneal Dialysis
♡ TYPES
✧ Intermittent Peritoneal Dialysis
○ Intended for acute and
chronic.
○ Lasts 48-72 hrs; cannot be
done manually (cycler
machine).
○ Needs hospitalization.
○ Makes use of permanent or
♡ Peritoneal Fluid:
temporary catheter
✧ 1.5% - weak solution.
✧ Continuous Ambulatory Peritoneal
✧ 2.5% - medium solution.
Dialysis
✧ 4.25% - strong solution.
○ Done regularly (3, 4, 6x
daily)
○ No need for hospitalization
○ Home dialysis.
✧ Automated Peritoneal Dialysis disability w/ no ◆ Check exit site for
○ New method helper. presence of
○ Performed at home; while ✧ REMINDERS: infection (C&S)
pt is asleep using Cycler ○ Clean work surface ◆ Give medication.
machine. ○ Use of mask and wash
○ Pt is able to go w/ SDL’s. hands thoroughly ➔ HEMODIALYSIS
○ Suitable for end-stage renal ○ Check SCALE of soln bag: ♡ Most common treatment for advanced and
disease patients ◆ Strength permanent kidney failure.
○ Strongly indicated for ◆ Clarity of soln ♡ Blood flows a few ounces at a time through
patients with: ◆ Amount the machine and is returned to the body
◆ unstable CV ◆ Leaks in bag after being cleaned.
disease, increased ◆ Expiration date ♡ VASCULAR ACCESS
intracranial ✧ AV fistula
pressure, difficult ♡ INFECTIOUS COMPLICATION ✧ Percutaneous catheter
to establish ✧ Peritonitis ✧ Graft
vascular access. ○ Most common compilation
○ Contraindicated for: ○ Inflammatory inflammation
◆ Severe of peritoneum.
Inflammatory ○ S&S - peritoneal
disease (acute inflammation, and
active diverticulitis, tenderness and rigidity.
active ischemic ○ Caused by break in
bowel disease, peritoneal technique
abdominal causing touch or airborne
abscess) infection.
◆ Severe psychotic ○ NSG Int:
disorder (manic ◆ 4 hrs dwell before
d/o); marked submitting
intellectual specimen
➔ Cont hypotension; reinforce fluid and diet ✧ Air Embolism
♡ Initial Nursing Assessment requirements. ○ Caused by:
✧ Weigh patient pre-post dialysis ✧ Weigh patient before leaving the ◆ Use of blood pump
✧ Vital signs center. - High negative
✧ Promote comfort ♡ Management of Complications pressure
✧ Keep pt informed of progress ✧ Hypotension ◆ Empty bottle
✧ Provide diversional activities ○ Lightheadedness, dizziness, connected to blood
✧ Provide care and attention yawning, fainting, line.
♡ Monitor for complications collapsing. ◆ Defective line and
✧ Infection ○ Caused by: air detector.
○ Fever and chills ◆ Excess (machine)
○ Redness around access ultrafiltration / ◆ Alarm should
✧ Bleeding excess fluid always be on.
○ Site bleeding / blood leaks removal. ○ S&S
○ Monitor for ◆ Excess blood in ◆ Dyspnea
hyper/hypotension. extracorporeal ◆ Cough
○ Press area and secure circuit. ◆ Cyanosis
dressing with elastic band. ◆ Intake of ◆ Respiratory arrest
♡ Post-dialysis anti-hypertensive ◆ Loss of
✧ Check for bloodwork or medicine to drug 1 hr before consciousness
be given before termination of treatment ○ NSG Int.
dialysis. (ex. Prophylaxis / Heparin) ✧ Muscle Cramps ◆ Check for tubes or
✧ Upon removal, apply pressure ○ Caused by: air detector.
dressing and wait until the puncture ◆ Rapid sodium and ◆ Clamp IV after NSS.
site has clotted. water removal ◆ Pt on the left side;
✧ Tape pressure dressing and instruct during dialysis. feet higher than
to remove 4-5 hrs later. ◆ Neuromuscular head.
✧ Possible bleeding - rest for 15 mins; sensitivity ◆ Administer O2 in
dangle legs to prevent postural secondary to high concentration
uremia.
 ◆ Catheter aspiration first few horse of
on the right side of dialysis
heart. ◆ Must be ordered by
✧ Disequilibrium Syndrome doctor
○ S&S
◆ Headache
◆ Restlessness
◆ N&V
◆ Hyper and
Hypotension
○ Anticonvulsant drugs given
to prevent occurence prior
to dialysis.
○ Causes:
◆ Reduction of
extracellular fluid
osmolality.
◆ Increased ICF and
CSF acidosis
◆ Reduction of O2
delivery to tissue
○ Intervention
◆ Slow infusion of
hypertonic sodium
chloride
◆ Glucose, dilantin
prior to dialysis.
◆ Reduce duration
and flow rate at